How can he tell

[denistd]

I have just come home from hershey Medical Center in PA. They did a videostrobe of my throat last week. The doctor told me today I had throat cancer. My voice is gone. I had a left side carotid endarectomy 2 days before Christmas. All of my symptoms started after the surgery, like the day after, the sore throat was there when I woke up in ICU. I saw my family doctor, the surgeon who did the endarterectomy and an ENT locally, all said my symptoms were due to the endarterectomy. The first ENT I saw did a scope of my throat and said all was well. Now I have this doctor saying it's throat cancer., he cannot see the tumor but tells me it's there on a paralyzed vocal cord. They are going to put me in surgery next week to scope out the throat more thoroughly and take a chunk of the tumor for biopsy to determine stage and type. Now this is Hershey here, Penn State University's med center, ultra modern. could it possibly not be cancer.?

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
The gold standard for diagnosis of cancer remains, to this day, a microscopic histo-pathological examination of the affected tissue. Examination under laryngoscopy / videostrobe may suggest possible presence of cancer if a characteristic mass is visible. However, only a biopsy of the tumor will confirm presence or absence of cancer. Early stage Head and Neck cancer (including that of the vocal cord) is treatable in a majority of cases with a multi-disciplinary oncology team approach.
In rare cases, infection or granuloma may mimic a malignant growth.
In your case, there is a strong temporal association between the endarterectomy surgery and appearance of your hoarseness. Also, the doctor "cannot see the tumor".
Only after an exploration under anesthesia and possible biopsy and imaging (PET-CT) can your condition be diagnosed for sure.
All the best, and God bless!

[denistd]

Thank you for your prompt response. I did not explain very well all of my symptoms. The sore throat is exactly like a case of acute pharyngitis, which I have had a couple of times in the past, it is on the left side and at times I have earache. I have sensations going from behind my ear up to the top of my head, I cannot categorize it as pain, just a sensation that sometimes is itchy. In May of 2008 I had a quadruple bypass. a few hours after surgey I was in the ICU and started babbling. The staff in the hospital thought I was having a stroke. They rushed me into a cat scan that showed no damage. They reopened my chest to see if there was something going on but there was not and they glued me back together again. They then said I was allergic to Dilauded. About a month later I had an episode where I got confused about pronunciation of words. Then in December I felt something again and went to the emergency room. While on the gurney with a doctor there I had another incidence of babbling. The doctor moved me to a holding room to wait to be admitted, I had another incident. He put me on a heparin IV and told me I was having TIA's. I was admitted. They ran every conceivable test, cat scan which showed nothing wrong, several x-rays, chest head neck and MRI's with and without contrast. I had a 90% blocked left carotid artery and was scheduled for the endarterectomy. The doctor said he had trouble getting the artery away from the neck wall due to it being rigid with the occlusion. Since then I have had these throst symptoms. I am on plavix and take an aspirin once a day. By the way I am a Brit living in the US. I was let out of the hospital on December 24th only to get a phone call from my brother telling me my mother in England had died that day, she was 95 and it was no surprise as she had Altzheimers disease.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
The transient and recurrent nature of your symptoms makes it is difficult to pinpoint cancer of the larynx as the underlying cause. CT scan too is normal, and shows no growth or suspicious mass.
I would, at this point, wait for detailed local examination and biopsy to be done, and not jump to any conclusions about the underlying problem causing your sore throat.
All the best, and please keep me posted.

[denistd]

Dear DR.

On Thursday I unerwent exploritory surgery on my throat to determine the extent and what it might be. There clearly is a small mass present, I was shown the cat scan. The doctor went into my throat and down my esophagus. he said that it appears this lump is a squamus cell carcinoma, it's the only thing in there and is not too large. 14 years ago I had an inverted papiloma removed from this exact spot, also whem I was in Hospital for my endarterectomy they took a cat scan of my throat because I was complaining of throat pain. They did not tell me that it showed a nodule growing there, nor did the first ent I saw. I read up on all of this and a papiloma usually does grow back as a squamus cell carcinoma. I revisit the doctor on Friday to docuss and decide on options, thank you for your interest sir, I will keep you informed. Denis

[Kamal S Saini, MD, MRCP (UK), DM]

Hi Denis,
By the time you meet your doctor on Friday, the biopsy report too would be probably ready and the diagnosis would have been confirmed. Thus you can have a detailed discussion about prognosis, staging, treatment (surgery versus chemo-radiation), and follow-up.
As I had said earlier, Head and Neck cancers are responsive to treatment in the majority of patients. I hope that you too have a good, durable response.
All the best!